As a storm ravaged Delmarva in January 2018, the peninsula was struck by subzero wind chill, hurricane-force wind gusts and snow.

Nikki and Tyler Watkinson were driving from Greenbackville, Virginia, in the heavy snow as Nikki — at 24 weeks pregnant — continued to feel pressure.

“I had no idea I was in labor," Nikki said.

With the blizzard, dubbed winter storm Grayson by media outlets, already plowing through the peninsula, Tyler needed to navigate the drive with 4 inches of snow on the roads.

Tyler drove quickly, but safely as he could to reach the local hospital. The pair both have medical backgrounds with Nikki being an emergency room registered nurse at Peninsula Regional Medical Center and Tyler a firefighter/paramedic with the Salisbury Fire Department.

“I was literally screaming in his ear 'please help me,' " she recounts.

As the couple endured the 40-minute ride, Nikki felt the urge to push, causing her water to break. The next push brought their micro preemie son, weighing 1 pound, 11 ounce, into the world — on the truck's front seat — at 12:39 a.m. Jan. 4.

"Is he breathing?" Tyler asked.

“He got out three little cries," she responded.

The Watkinson's son came into the world in his own storm and, after transferring hospitals, spent the next four months at the Children's National Health System neonatal intensive care unit in Washington, D.C.

Today, baby Grayson is happy and healthy. In mid-December, Nikki recounted the family's story to first lady Melania Trump during a return visit to the D.C. hospital . This month, they're celebrating Grayson's first birthday.

First Lady Melania Trump poses for a photo with patients at Children’s National Thursday, Dec. 13, 2018, during a Christmas visit to the hospital in Washington, D.C. (Official White House Photo by Andrea Hanks) Courtesy of The White House.(Photo: Submitted Image)

She said the first lady enjoyed hearing the story and told her Grayson would be interested in hearing his birth story as he gets older.

“It was amazing, she was so sweet," she said.

Tara Floyd, Children's National Neonatal and Pediatric Intensive Care Nursing director likes how the hospital has this national platform to share families stories. She was part of the event when Trump visited NICU for the first lady. Before 2018, the NICU last hosted the visit in 2011.

“Kids are just super resilient, and I don’t think the average person walking around on Michigan Avenue has any idea really that we are able to save these 1-pound babies now," she said.

A treacherous hospital journey: Truck to ambulance to snowplow

Earlier in the night Grayson was born, Nikki and her OB-GYN doctor thought her pain could be caused by an urinary tract infection.

But, after taking prescription medicine, her condition continued to worsen.

“The pain just kept getting worse and worse," she remembers.

This is what led to the Watkinson's drive to PRMC.

As Nikki found a wax rag in the back of the truck to wrap Grayson in for warmth, Tyler called the Snow Hill Volunteer Fire Department to let paramedics know they needed assistance.

As Grayson was swaddled in the wax rag and Nikki's jacket, the couple made it to the Snow Hill firehouse, where mother and child were scooped into an ambulance. Grayson's color was blue and his bronchial pulse was low, so Nikki began doing compressions on her newly born infant.

The infant couldn't be intubated in the ambulance, but paramedics were able to bag him, or delivered oxygen to the lungs through a breathing device. Nikki wanted Tyler to ride in the ambulance with them, but he needed to keep their truck for transport.

On the way to PRMC, he called the charge nurse to let them know they were coming. When the Snow Hill ambulance arrived, Nikki instructed the nurses to not stop compressions on Grayson.

Within two minutes he was intubated, got his stats and pulse up.

“He was more or so stabilized,” Nikki said.

With their medical backgrounds, Nikki said Tyler was able to contribute calmness to the situation which allowed her to focus and make sure Grayson was OK.

“People tell me all the time if it was anybody else, he wouldn’t have made it,” Nikki said.

A premature baby is born before reaching 37 weeks in the womb, according to March of Dimes. A micro preemie is born around 24 to 26 weeks, possibly even as early as 22 to 23 weeks, said Dr. Lamia Soghier, Children's National medical unit director.

A micro preemie is born on the borderline of viability meaning if they were born a week or two before, they probably would have died because their systems are so immature, Soghier said.

Pregnancies should be carried as close to full term as possible as long as there is no risk to the health of the pregnant mother or her fetus to avoid vulnerable preemies experiencing a delay in brain development, according to study results published by Pediatrics in October in a news release from Children's National.

During the third trimester, or the final 13 to 14 weeks of gestation, fetuses’ brains grow exponentially, and the body shifts energy to the brain to accommodate the neurological growth spurt. As the brain size increases four-fold, it develops critical structures and connections that will be relied upon for life, according to a news release.

Being born that early, the infant's body still hasn't developed many of the things a full-term baby has. The brain is smooth and the lungs haven’t developed fully, among other concerns, Soghier said.

Babies born that small can sometimes be born with their eyes fused shut, Floyd said.

This is why every way the NICU takes care of a micro preemie and how quickly they react is incredibly important to quality of life.

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Melania Trump is keeping up the first ladies' tradition of a Christmas season visit to a Washington children's hospital. (Dec. 13)
AP

“The smaller you go in gestation the more you need to pay attention to that,” Floyd said.

Being born at 24 weeks and weighing 1 pound, 11 ounces, Grayson couldn't stay at PRMC's NICU due to the equipment and specialist care he needed, leading to his transport to Children's National.

PRMC's NICU is a level two, offering care to babies born at or after the 32 week mark, according to the Children's National website. While Children's National is a level four, offering the highest level of care to babies born even at the youngest week of viability.

PRMC's NICU is staffed with Children's National employees making communication and transfer of care simple.

With inches of snow piled up outside, going by air was not an option. This led to the over two-hour trek by ground with the neonatal transport team.

Through Salisbury Mayor Jake Day and Maryland State Highway Administration, a plan was made for snowplows to travel with the ambulance to make a clear path in the heavy snow.

“It was a very long transport just to get us out and safely to him," said Meghan Sullivan, Children's National neonatal nurse practitioner.

The roller coaster of the NICU

Sullivan performed her final transport leaving Washington, D.C., to pick up Grayson via ambulance. On a regular day, the hospital would have flown to get Grayson from PRMC but, because of the weather, they weren’t able to do that.

Sullivan said the trip back to Children's National was still long and bumpy as they had to watch out for bilateral bleeds inside of Grayson's brain.

“I ended up spending most of the time especially across the Bay Bridge under Grayson sort of holding him in mid-air because the bumps were so bad and we didn’t want to make his poor little head any worse than it was,” Sullivan said.

When the transport team got Grayson to Children's National, he was mostly stable but still needed quite a bit of support, Sullivan said.

“The transport had been very long, and he was sort of still honeymooning in that first 24 hours," she said.

"Honeymooning" means the infant is showing signs of being healthy with no issues but later down the line, complications of being born so prematurely will begin to show. Many babies in the NICU take two steps forward and one step back while fighting for their lives.

“Grayson was definitely the poster child for the roller coaster ride that is the NICU," Sullivan said.

Saving a micro preemie starts with respiratory support in the form of mechanical ventilation until he was able to effectively breathe on his own. Next, total parenteral nutrition was given through his veins to provide the proper nutrition he needed to grow, and medications are given through central lines, Prothro said.

She explained careful monitoring and stabilization of his vital signs were essential in the beginning and frequent labs are taken from an arterial line. There was also much concern about Grayson's developing brain and, therefore, neonatal neurologists followed him closely.

For four months, Nikki and Tyler stayed at the Ronald McDonald House Charities while Grayson was treated in the NICU. The couple shared updates on their journey through a Facebook page with family and friends.

Nikki gets emotional as she remembers the various health scares Grayson went through during his stay. While friends and family watched over their dogs and home in Virginia, the couple stayed in the D.C. area. They would arrive at the hospital around 8 a.m. daily and stay with their newborn until about 10 p.m.

Grayson needed to be intubated for large portion of his stay. He also needed to use the High Frequency Oscillator Treatment to help with breathing. He had blood pressure issues causing him to need to take various medications. He was also treated for a fungal infection of which Nikki said no one knew the cause.

The infant received multiple blood transfusions and underwent patent ductus arteriosus surgery, a type of heart duct surgery. This surgery was performed at his bedside as this keeps the baby safer than taking a trip to the operating room.

“(Our) NICU has the ability to do that other units don’t,” Prothro said.

He also had bilateral hernia repair.

But the biggest worry for Grayson and his parents were his grade four bilateral bleeds in the brain.

Sullivan explained in premature babies the blood vessels in the brain are easily broken. This was why Grayson's transport and movement inside the hospital needed to be watched closely.

“Those little bumps and everything can cause the bleeding in the brain,” she said.

Bilateral bleeds are measured on a one to four scale, Prothro said.

Sullivan explained with a grade four, bleeding has filled part of the ventricles in the brain and has started to put pressure on the brain itself.

When the bleeds were discovered Nikki and Tyler were told to really think about what quality of life they wanted to give their son.

“They told us we’re probably going to have to make harder decisions and pull the plugs pretty much," Nikki said with tears in her eyes.

But the couple stood by their son, visiting him daily and praying he would pull through.

After more time and healing, the breathing tube was removed and he began to slowly get breastmilk through a feeding tube. From here he kept feeding and growing until he was strong enough to go home, Prothro said.

But she also credited Nikki and Tyler's constant presence to Grayson's health.

“It made all the difference in his outcome," Prothro said.

With an original diagnosis of little to no brain function or cerebral palsy, the Watkinson took Grayson home after four months with the only concern being fine motor skills with his hands.

“To go from telling us we’re going to have to make some harder decisions to him being here is just nothing short of a miracle," Nikki said.

Grayson turns 1

Grayson is now a happy and alert baby after a whirlwind first few months.

The Children's National staff was happy to see Nikki be able to share that story with Trump and everyone else in the NICU during the December event.

“I’m really glad he got this once-in-a-lifetime opportunity, and I’m sure he’ll have some unique pictures to share in his baby book! The first lady is a mother, too, so I imagine she understands how hard it is for our NICU families to be here, and why we do everything we can to help children. Grayson and all our NICU babies are like family to us,” Floyd said.

First lady Melania Trump reads "Oliver the Ornament" to children at Children's National Health System on Thursday, Dec. 13, 2018, in Washington.(Photo: Andrew Harnik, AP)

When Grayson is at home, he loves to play with the family's dogs, listen to his parents read and watch "Mickey Mouse Clubhouse."

He still needs to do physical therapy regularly for the motor skill issues and, like every premature baby, will have neurological visits every 6 months until he's 2 years old.

Nikki and Tyler make sure to be diligent with deciding where to take Grayson and who can visit as respiratory syncytial virus is in season in colder months. If the baby were to get sick, his body would need to work harder to fight the respiratory virus than a baby who was born at full-term. The fear of having to end up back in the NICU with a sick baby is always in the back of Nikki's mind.

“It’s just one day at a time with him, but he’s just the happiest baby you’ll ever meet in your entire life,” she said.

The baby is continuing to meet milestones, now weighing 16 pounds, 3 ounces. Nikki said his growth chart shoots straight up as he continues to grow and catch up to other children his age.

To celebrate Grayson's 1st birthday, the Watkinsons will hold a small party with close family and friends. For this family of three, every day is a celebration they're able to have their baby at home.

“Not many people get to be this lucky to bring their baby home out of the NICU when they’re born at 24 weeks," Nikki said.

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First Lady Melania Trump poses for a photo with patients at Children’s National Thursday, Dec. 13, 2018, during a Christmas visit to the hospital in Washington, D.C. (Official White House Photo by Andrea Hanks) Courtesy of The White House. Submitted Image

First lady Melania Trump greets patients in the audience after reading "Oliver the Ornament" to children at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Andrew Harnik, AP

First lady Melania Trump is given flowers by Tearrianna Cooke-Starkey, left, and Nathan Simm, right, after she reads "Oliver the Ornament" to children at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Andrew Harnik, AP

First lady Melania Trump, accompanied by author Todd Zimmermann, left, Tearrianna Cooke-Starkey, second from left, and Nathan Simm, right, reads "Oliver the Ornament" to children at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Andrew Harnik, AP

First lady Melania Trump reads "Oliver the Ornament" to children at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Also present is the author of the book, Todd Zimmermann, center right. Andrew Harnik, AP

First lady Melania Trump reads "Oliver the Ornament" to children at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Also present is the author of the book, Todd Zimmermann, center. Andrew Harnik, AP

First lady Melania Trump arrives with Tearrianna Cooke-Starkey, left, and Nathan Simm, right, to read "Oliver the Ornament" to children at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Andrew Harnik, AP

First lady Melania Trump greets children released from the neonatal intensive care unit (NICU) and their parents at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Andrew Harnik, AP

First lady Melania Trump arrives to greet children released from the neonatal intensive care unit (NICU) and their parents at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Andrew Harnik, AP

First lady Melania Trump greets children released from the neonatal intensive care unit (NICU) and their parents at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Andrew Harnik, AP

First lady Melania Trump greets children released from the neonatal intensive care unit (NICU) and their parents at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Andrew Harnik, AP

First lady Melania Trump greets a shy boy who was released from the neonatal intensive care unit (NICU) at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Andrew Harnik, AP

First lady Melania Trump greets children released from the neonatal intensive care unit (NICU) and their parents at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. At right is Nikki Watkinson, holding baby Grayson. Andrew Harnik, AP

First lady Melania Trump arrives to greet children released from the neonatal intensive care unit (NICU) and their parents at Children's National Health System on Thursday, Dec. 13, 2018, in Washington. Andrew Harnik, AP